Acil serviste hemodiyaliz alan hastaların değerlendirilmesi

Yıl 2020, , 915 - 919, 01.11.2020

Suna Eraybar , Melih Yüksel

https://doi.org/10.28982/josam.747306

Öz

Amaç: Akut renal hasar(ARH) hasta karakteristiklerine, komorbiditesine ve klinik durumuna bağlı olarak yüksek mortalite ve morbiditeye sahip önemli bir acildir Akut böbrek yetmezliğinin (ABY) hızla tanınıp, renal replasman tedavisinin (RRT) başlanması, bu hastaların hayatta kalımını belirleyen en önemli unsurlardan biridir. RTT’nin acil serviste başlanması ise kritik hastada doğru endikasyonların konulmasına, kaynakların doğru kullanımına ve nefrolojik takibin etkin şekilde sağlanmasna bağlıdır. Bu çalışmanın amacı acil serviste ilk kez hemodiyaliz alan hastaların hemodiyaliz endikasyonlarını belirlemek ve bu uygulamanın hastaların rutin hemodiyalize alınması ve sağ kalımları üzerine etkisini araştırmaktır.
Yöntemler: 01 Ocak 2019- 31 Aralık 2019 tarihleri arasında acil serviste santral kateterizasyon işlemi yapılan ve hemodiyaliz uygulanan hastalar retrospektif olarak incelendi. Hastalara ait yaş, cinsiyet, kronik hastalık varlığı, acile geliş semptomları, laboratuvar değerleri hastane otomasyon sisteminde kayıtlı hasta dosyaları üzerinden kaydedildi. Hastaların acil hemodiyaliz sonrası hastaneye yatış ya da taburculuklarına ait veriler toplandı. Hasta kayıtlarından hasta takibi gerçekleştirilerek hastaların acil diyaliz alımı sonrası 3 aylık sürede nefroloji poliklinik takipleri incelenerek rutin hemodiyaliz programına alınımları ve 28 günlük mortaliteleri değerlendirildi. 18 yaş üzerinde olup acil serviste kateterizasyonu sağlanarak ilk diyalizi acilde serviste alan hastalar çalışmaya dahil edildi.
Bulgular: Çalışmaya toplam 185 hasta dahil edildi. Hastaların %55,1‘i (n=102) erkek olup ortalama yaş 65,63 (15,92) olarak saptandı. Hastaların %49,2’ si (n=91) sonrasında rutin hemodiyaliz programına alınırken, %22,7’sinde ise (n=42) 28. günde mortalite geliştiği gözlendi. Hastaların mevcut sistemik hastalıkları ve hastaların diyalize alınma endikasyonları ile rutin hemodiyaliz programına alınması arasında da istatistiksel olarak anlamlı bir ilişki saptanmadı (P=0,327, P=0,45).
Sonuç: Bu çalışmada her ne kadar hastaların diyalize alınma endikasyonları ile rutin diyaliz programına alınmaları arasında istatistiksel olarak anlamlı bir ilişki çıkmamasına rağmen acil hemodiyaliz önemli bir prosedürdür ve hastanın klinik tablosu ve laboratuvar değerleri eş zamanlı değerlendirilmelidir. Özellikle elektrolit bozuklukları ve intoksikasyonların takip ve tedavisinde hemodializ için geç kalınmamalı ve hastanın tedavisine hızla karar verilmelidir.

Anahtar Kelimeler

Acil servis, Diyaliz, Akut böbrek hasarı, Hiperkalemi

Destekleyen Kurum

yoktur

Proje Numarası

yoktur

Evaluation of patients receiving hemodialysis in an emergency service

Öz

Aim: Acute kidney injury (ARH) is an important emergency with high mortality and morbidity depending on patient characteristics, comorbidity and clinical situation. Rapid recognition of acute renal failure (ARF) and initiation of renal replacement therapy (RRT) is one of the most important factors determining the survival of these patients. The initiation of RTT in the emergency department depends on the correct indications in the critical patient, the correct use of resources and effective nephrological follow-up. This study aims to determine the hemodialysis indications of patients undergoing hemodialysis for the first time in the emergency service and to investigate the effect of this application on routine hemodialysis and survival.
Methods: We carried out a retrospective cohort study with patients who underwent hemodialysis for the first time by central venous catheterization in the emergency service between January 01, 2019 and December 31, 2019. Age, gender, presence of chronic disease, symptoms and laboratory values of the patients were recorded from the patient files in the hospital automation system. Data regarding the hospitalization or discharge of the patients after emergency hemodialysis were collected. Patient follow-up was carried out from the patient records, and the nephrology follow-ups were examined for 3 months after emergency hemodialysis. Their routine hemodialysis and 28-day mortality were evaluated.
Results: A total of 185 patients were included in the study. 55.1% of the patients (n=102) were male and the mean age was 65.63 (15.92) years. While 49.2% (n=91) of the patients were included in the routine hemodialysis program, mortality developed in 22.7% (n=42) on the 28th day. No statistically significant relationship was found between the current systemic diseases, hemodialysis indications and undergoing routine hemodialysis program (P=0.327, P=0.45).
Conclusion: Although there was no statistically significant relationship between the dialysis indications of the patients and their inclusion in the routine dialysis program, emergency hemodialysis is an important procedure. The clinical condition and laboratory values of the patients should be evaluated synchronously. Physicians should not be late in initiating hemodialysis in the follow-up and treatment of electrolyte disorders and intoxications; the treatment of the patient should be decided as quickly as possible.

Anahtar Kelimeler

Emergency Departments, Dialysis, Acute kidney injuries, Hyperkalemia

Proje Numarası

yoktur

Kaynakça

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